Provider First Line Business Practice Location Address:
115 WEST PEACE ROAD
Provider Second Line Business Practice Location Address:
PRAIRIE VIEW DENTAL
Provider Business Practice Location Address City Name:
SYCAMORE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-895-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2006